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True Consult Request or Transfer of Care?

  1. #1
    Default True Consult Request or Transfer of Care?
    Exam Training Packages
    We have an area doc who faxes over a form to our specialists requesting visits for his patients. The form is titled "Consult Request". The doc then provides the reason but then writes "Requested Disposition: Assume management for this particular problem". The docs see the words "consult request" and want to bill the consult codes. I see the words "assume management" and am not sure it would support a consult since it sounds like a transfer of care, no matter what the form is called. What do others think??
    Thanks for your opinions!
    Sue
    Sue Vermette, CPC

  2. #2
    Default transfer
    Quote Originally Posted by SUEV View Post
    We have an area doc who faxes over a form to our specialists requesting visits for his patients. The form is titled "Consult Request". The doc then provides the reason but then writes "Requested Disposition: Assume management for this particular problem". The docs see the words "consult request" and want to bill the consult codes. I see the words "assume management" and am not sure it would support a consult since it sounds like a transfer of care, no matter what the form is called. What do others think??
    Thanks for your opinions!
    Sue
    In this scenario, I say it's a transfer, not a consult. It depends on the intent at the first visit. Your Dr wants the other's to assume care, therefore, can't be considered a consult. Just my 2 cents!

  3. #3
    Default
    Doesn't matter what the form says, it is the intention. If they state assume management, you are right it is a transfer of care.

    Out hospital has a lovely form for the inpatient chart it is titled

    "Consult or Co-Management"

    Of course all my specialists try to go for option 1, when in fact the request itself is for co-management.

    I was told by a co-worker who attended a HCPro audio conference yesterday that the 2010 proposed rule is saying they are going to get rid of consults next year. I can't find anything on it yet myself, but I will be doing the happy dance if they do.

    Laura, CPC, CEMC

  4. #4
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    Default
    I agree with the others. It is the intent of the requesting physician that determines the type of visit. Not to mention the other criteria for consultations. I have also heard rumors about consultation codes going away in 2010. I would be very happy if that happened.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Smile consult or not
    The May 2009 Coding edge page 20 has a great article on consult or not. I faxed it to all my clinics. Yours sounds like a tranfer of care to me also.
    Colleen R Cox CPC

  6. #6
    Default consult
    Quote Originally Posted by katmryn78 View Post
    Doesn't matter what the form says, it is the intention. If they state assume management, you are right it is a transfer of care.

    Out hospital has a lovely form for the inpatient chart it is titled

    "Consult or Co-Management"

    Of course all my specialists try to go for option 1, when in fact the request itself is for co-management.

    I was told by a co-worker who attended a HCPro audio conference yesterday that the 2010 proposed rule is saying they are going to get rid of consults next year. I can't find anything on it yet myself, but I will be doing the happy dance if they do.

    Laura, CPC, CEMC

    Here's where you can find the Physician final rule proposal. The consult issue is in the 5th paragraph. Interesting reading!

    http://www.cms.hhs.gov/apps/media/pr...&cboOrder=date

  7. #7
    Default Thanks Anna
    Very interesting indeed. I wonder if they will actually increase payments on the other E/M or just not cut them anymore...

    Laura, CPC, CEMC

  8. #8
    Default
    I would treat this as a transfer of care. He is obviously not wanting just a specialist opinion and then deciding whether or not to treat himself or transfer. Now, if he were to send over the consult request, then your doc sent back a report, then the requesting physician sent over a request to assume care then I would go ahead and bill a consult initially. It may just be a matter of changing his process a bit but then you are left with a "sticky" situation of it being looked at as just a way to get the consult code out of it knowing he is going to end up transferring care every time. In short, if it were I, would bill for a new pt visit/transfer of care.

  9. #9
    Default
    Thanks to all of you for your responses and the great info! I'll be interested to see what the commercial insurances do with consult codes if CMS decides to cease payment for them in the future...
    Sue
    Sue Vermette, CPC

  10. #10
    Default
    It seems to become a reality that there will be no more consults. If this proposed rule passes it would be interesting to see how it all works out especially with inpatient services. I would speculate that private payers may drop those codes as well. That's what happened when they stopped the confirmatories (99271-74).
    Karolina, CPC, CPMA, CEMC

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